Medullary Thyroid Carcinoma: A Unique Case Report.

Medullary thyroid carcinoma is a rare neuroendocrine tumor derived from parafollicular C-cells. It can be inherited as part of syndromes, such as familial medullary thyroid cancer (FMTC) and multiple endocrine neoplasia type 2 (MEN 2), or it can arise sporadically. We herein report a unique case of medullary thyroid carcinoma in a 50-year-old male who presented with a neck mass. Fine needle aspiration cytology (FNAC) of the thyroid and histopathological examination revealed a diagnosis of medullary thyroid carcinoma. Both carcinoembryonic antigen (CEA) and calcitonin are the key serum markers utilized in the diagnosis and monitoring of medullary thyroid cancer (MTC). Thorough evaluation, prompt identification, and efficient treatment constitute the pivotal measures for ensuring favorable survival outcomes.

Unlocking Precise Lung Cancer Detection Through Minimal Panel Immunostaining in Small Biopsy Samples.

Introduction Lung cancer diagnosis faces challenges due to morphological heterogeneity and limited biopsy tissue. This study evaluates the efficacy of a minimal panel immunostaining technique using immunohistochemical markers like napsin A, thyroid transcription factor 1 (TTF-1), p63, and synaptophysin to improve the precision of lung carcinoma subclassification. Methods A retrospective analytical study was conducted at the Histopathology Laboratory of Saveetha Medical College and Hospital, Chennai, from January 2018 to February 2024. A total of 64 lung carcinoma cases were analyzed. Inclusion criteria included biopsy samples from lung lesions with a confirmed diagnosis of lung carcinoma based on histomorphological examination, covering all age groups and both genders. Non-carcinomatous lung lesions were excluded. Clinical data were obtained from the Medical Information Archiving Software (MIAS) database and histopathological examination request forms. Under a light microscope, tissue samples were examined after being fixed in formalin, processed, and stained with hematoxylin and eosin (H&E). Additionally, a minimal panel of immunohistochemical markers, including napsin A, TTF-1, p63, and synaptophysin, was used to subclassify lung carcinomas. Results The age group older than 50 years was the most affected, with a higher incidence in males. Histologically, 49% of cases were adenocarcinoma, 42% were squamous cell carcinoma, and 9% were small cell carcinoma. Immunohistochemistry (IHC) results adjusted these proportions to 54.6% adenocarcinoma, 31.2% squamous cell carcinoma, and 14% small cell carcinoma, showing a 5.6% increase in adenocarcinoma cases. The most common adenocarcinoma pattern was mixed, followed by acinar. TTF-1 and napsin A were crucial for identifying adenocarcinoma, while p63 was key for squamous cell carcinoma. Synaptophysin confirmed neuroendocrine differentiation in small cell carcinoma. Conclusion Incorporating a minimal panel of IHC markers significantly enhances the accuracy of lung carcinoma subclassification, addressing diagnostic challenges posed by morphological heterogeneity and limited sample size. This approach supports more precise and efficient clinical care for patients with lung cancer. Further validation in diverse clinical settings is recommended.

Assessment of Pre-analytical Errors and Fostering Strategies to Enhance Accurate Results and Efficient Turnaround Times in the Cytology Laboratory of a Tertiary Care Hospital.

Introduction Pre-analytical errors in cytology laboratories can significantly impact the accuracy of diagnostic results and turnaround times, ultimately affecting patient care. This article presents an evaluation of pre-analytical errors and proposes fostering strategies to enhance accuracy and efficiency in the cytology laboratory of a tertiary care hospital. The background discusses the importance of pre-analytical processes in ensuring reliable cytological diagnoses and the common errors encountered in specimen collection, handling, and transportation. Strategies for error reduction and improvement in turnaround times include staff education, standardization of procedures, utilization of appropriate collection and transport devices, implementation of quality control measures, and utilization of automation technologies. By addressing pre-analytical errors and implementing fostering strategies, cytology laboratories can optimize diagnostic accuracy, improve patient care outcomes, and enhance overall laboratory efficiency. Aims and objectives This study aims to assess the prevalence and nature of pre-analytical errors in the cytology laboratory of a tertiary care hospital to understand the extent of the issue, identify the specific factors contributing to pre-analytical errors like specimen collection, handling, and transportation processes, and pinpoint areas for improvement. It seeks to evaluate the impact of pre-analytical errors on the accuracy of cytological results and the efficiency of turnaround times, highlighting the consequences for patient care. Furthermore, the study aims to develop targeted strategies to minimize pre-analytical errors and enhance the accuracy of cytological results. Materials and methods This study was conducted at the Cytology Laboratory of our hospital from January 2023 to December 2023 after getting proper approval from the Institutional Review Board (IRB approval number 101/02/2024/PG/SRB/SMCH). It is a retrospective analytical study, and a total of 5412 samples from patients of the outpatient (OP) department, inpatient (IP) department, and community health outreach program facilities received in the cytology laboratory were analyzed during the study period. The inclusion criteria were the test samples sent specifically for cytological analysis. The samples sent for biochemical or microbiological examination were excluded. The frequency of sample distribution and rejected samples were calculated and the results were correlated. Results A total of 5,412 samples received in the cytology laboratory were analyzed during the study period. The majority of the samples were Papanicolaou smears (2,352, 43.5%), followed by fluid cytology (1,008, 18.6%) and ultrasound-guided fine-needle aspiration cytology (FNAC, 984, 18.2%). Of the total number of samples, 225 (4.16%) were repeated and 27 (0.5%) were rejected. Conclusions Pre-analytical, analytical, and post-analytical processes are the three key factors that determine the dependability and precision of cytological test results. Detecting critical alerts such as the positivity of malignancy underscores the paramount importance of result accuracy. Implementing good laboratory practices and conducting both external and internal audits can reduce the frequency of preventable errors in a cytology laboratory, thereby ensuring enhanced precision and expedited outputs.

Exploring the Rare Case of a Sarcomatoid Variant of Urothelial Carcinoma.

A sarcomatoid variant of urothelial carcinoma (SVUC) is an extremely rare variant, which accounts for only 0.1-0.3% of all urothelial carcinomas of the bladder. SVUC is distinguished by the presence of biphasic components; there can be morphological and/or immunohistochemical substantiation of epithelial and mesenchymal differentiation. The patients with this variant have been associated with very poor disease-specific and overall survival rates in comparison with the high-grade pure urothelial carcinoma. Being a rare entity, it usually presents at a higher grade and is related to a dismal prognosis in comparison with conventional urothelial carcinoma. Careful examination, early diagnosis, and effective treatment are the most important steps for good survival. Here, we report a 58-year-old male who presented with complaints of hematuria for one and a half months with histopathology showing features of SVUC.

A Rare and Intriguing Case Report of Metaplastic Breast Carcinoma.

Metaplastic breast carcinoma (MBC) is a rare and aggressive subtype of breast cancer characterized by the presence of both epithelial and mesenchymal components within the tumor. Its clinical and radiological appearance is comparable to other types of breast cancer, but it grows rapidly. The diagnosis of metaplastic carcinoma is largely based on the epithelial origin of the cells confirmed by immunohistochemistry (IHC). Compared to invasive ductal carcinoma, metaplastic carcinoma has a worse overall survival rate. Any patient with a rapidly growing breast mass should be assessed with suspicion of sarcomatoid or metaplastic malignant neoplasm. We report this case due to its rarity and the complex nature of the disease.

Multifocal Primary Extranodal Non-Hodgkin Lymphoma: A Report of a Rare Case.

Primary extranodal non-Hodgkin lymphoma (NHL) is a rare manifestation of lymphoid malignancies and typically arises in tissues outside the lymph nodes and can involve various organs and anatomical sites presenting unique challenges in diagnosis and treatment. Multifocal primary extranodal NHL, characterized by simultaneous involvement of multiple extranodal sites, presents a diagnostic and therapeutic challenge due to its uncommon presentation and varied clinical manifestations. Despite advances in diagnostic modalities and treatment strategies for NHL, multifocal involvement poses unique clinical dilemmas requiring a multidisciplinary approach for accurate diagnosis and optimal therapeutic intervention. In this case report, we describe a rare case of multifocal primary extranodal NHL in a 29-year-old female, highlighting the complexities associated with its diagnosis and management. Through this case presentation, we aim to underscore the importance of recognizing and addressing the intricacies of multifocal primary extranodal NHL to enhance clinical outcomes and improve patient care. It also highlights the diagnostic complexity and clinical challenges associated with multifocal primary extranodal NHL. A multidisciplinary approach involving haematologists, oncologists, radiologists, and pathologists is crucial for the accurate diagnosis and optimal management of such cases. Additionally, further research is warranted to better understand the underlying pathogenesis and improve treatment strategies for this rare presentation of NHL.

A Rare Case Report of Dedifferentiated Endometrioid Carcinoma.

Dedifferentiated endometrioid carcinoma (DEC) is an exceptionally rare subtype of endometrial cancer characterized by a high-grade component juxtaposed with a low-grade endometrioid adenocarcinoma. This case report presents a unique instance of dedifferentiated endometrioid carcinoma in a 64-year-old female patient who presented with post-menopausal bleeding and abdominal pain. Diagnostic evaluation including imaging studies and histopathological examination revealed a mixed tumor comprising both high-grade and low-grade components. Management involved a multidisciplinary approach including surgical resection followed by adjuvant chemotherapy and radiation therapy. They are frequently mislabeled as endometrioid carcinomas of International Federation of Gynecology and Obstetrics (FIGO) Grade 2 or Grade 3. It is crucial to correctly differentiate these instances from traditional endometrioid carcinomas. This case underscores the importance of early recognition and comprehensive management strategies tailored to the unique characteristics of dedifferentiated endometrioid carcinoma. We report this case due to its rarity and complexity in diagnosis.